骨科患者伤口分泌物病原菌分布及耐药性分析

Distribution of Pathogenic Bacteria of Wound Secreta and Their Drug Resistance in Orthopedics Patients

目的:了解我院骨科患者伤口分泌物病原菌分布及其耐药性情况,为临床上对骨科患者合理使用抗生素提供相关理论根据。方法:将2013年2月至2014年8月我院282例术后骨科患者的伤口分泌物标本接种培养,按要求分离纯菌,采用VITEK 2Compact全自动微生物分析仪进行鉴定及药敏试验。结果:282份标本中分离出致病菌186株(65.96%),其中革兰氏阴性球菌94株(50.54%),革兰氏阳性球菌83株(44.62%),真菌9株占4.83%。分离率排在前三位的致病菌分别为阴沟肠杆菌(19.35%),金黄色葡萄球菌(17.20%),表皮葡萄球菌(15.59%)。阴沟肠杆菌、大肠埃希菌、肺炎克雷伯菌对头孢唑林和氨苄西林的耐药率最高,其中阴沟肠杆菌对头孢唑林耐药率高达100%。但未发现主要革兰氏阴性球菌对亚胺培南耐药。革兰氏阳性球菌对青霉素的耐药率较高,但未发现革兰氏阳性球菌对万古霉素耐药。结论:术后骨科患者伤口优势菌种是阴沟肠杆菌,而且耐药性高;临床医生应根据病菌鉴定和药敏分析结果,对不同种类的病原菌使用不同的抗生素进行针对性治疗。

Objective： To study the distribution of pathogenic bacteria of wound secreta and their drug resistance in orthopedics patients, and to provide theoretical basis for clinical rational use of antibiotics. Methods： The specimens of wound secreta of 282 postop- erative orthopedics patients, who were treated in the Affiliated Honghui Hospital of Medical College of Xi＇an Jiao Tong University from February 2013 to August 2014, were cultured and separated the pure pathogenic bacteria according to the standards, which were identified and implemented the drug sensitivity test by VITEK 2 Compact automated microbial analyzer. Result： 186 strains of pathogenic bacteria were separated from 282 specimens （65.96%）, including 94 strains of gram-negative bacilli （50.54%）, 83 strains of gram-positive bacilli （44.62%）, 9 strains of fungi（4.83%）. The top three of separated pathogenic bacteria were enterobacter cloacae（19.35% ）, staphylococcus aureus（17.20%）, and staphylococcus epidermidis（15.59%）. The highest drug resistance rates to cefazolin and ampicillin were enterobac- ter cloacae, eseherichia coil and klebsiella pneumoniae, and the drug resistance rate of enterobacter cloacae to cefazolin was 100%, but no drug resistance to imipenem was found in mainly gram-negative bacilli. The gram-positive bacilli had highest drug resistance rate to penicillin, but no drug resistance to vancomycin was found. Conclusion： The dominant pathogenic bacteria of wound secreta in postoper- ative orthopedics patients is is enterobacter cloacae, with high drug resistance. Clinicians should use different antibiotics for different kinds of pathogenic bacteria according to the results of bacteria identification and drug sensitivity analysis.